"May your mother and father rejoice; and may
the one who bore you thrill with joy." (Proverbs 23:25).

Mazel Tov on the birth of your son. And welcome to my
web page. This is an exciting time for parents,
grandparents and the entire family. The brit milah
(bris), or ritual circumcision, is a heartfelt and joyous
experience. Arranging for it, however, can be stressful
and confusing. Hopefully, the information I provide on this
site will help make preparations smoother.

As a board-certified obstetrician/gynecologist who has been
performing circumcisions for over thirty years, and a mohelet
(female mohel) performing brit milah since 2003, I will do my
best to make this day the significant event that it is in your
son’s life. My approach to the brit milah ceremony is
one of personal attention to your individual needs. I
work directly with the family to create a participatory
service that is shaped by the specific needs and desires of
the parents, intended to involve and include as many members
of the family as possible, within the bounds of halachic
requirements. I believe that everyone present at the ceremony,
whether Jewish or of any other background, should be able to
understand what is happening.

On the following pages, I present a brief overview of the
brit milah ceremony and the circumcision. Reading and
following this guide will help you make things go more
smoothly so that you, your family and your invited guests will
be in a better position to enjoy this event. Please do
not hesitate to contact me at any time, even if you only have
a question. I look forward to being a part of this
milestone in your son’s life when he is welcomed into the fold
of the Jewish people.

The Tradition

Brit milah literally means covenant of circumcision. This
covenant is between G-d and the Jewish people. The Torah tells
the story of G-d saying to Abraham: "I will establish My
covenant between Me and you and your children after you,
throughout all generations, as an everlasting covenant, to be
your G-d and your children's after you ... This is My covenant
which you shall keep ... every male among you shall be
circumcised. And you shall be circumcised in the flesh of your
foreskin; and it shall be a sign of a covenant between Me and
you." (Genesis XVII, 7-11).

In modern times the expression "every male among you" is
taken to mean every Jewish male among you. Circumcision does
not make a male child Jewish; he is Jewish if his mother is
Jewish or she had converted by the time of his birth. If a
baby is not Jewish, he may have a brit as the first step of
conversion.

Every Jewish father is obligated to circumcise his own son,
just as Abraham circumcised his own son, Isaac. However,
because most fathers are not versed in the Jewish laws
concerning brit milah, nor are they trained to circumcise, a
mohel is normally asked to serve as the father's stand-in. A
mohel (or mohelet) is a righteous Jew who has received
intensive instruction in the halakah (laws), minhagim
(customs), brit (entry of a child into the covenant), and
milah (surgical technique of circumcision). Any observant Jew
who has mastered these skills may become a mohel; one need not
be a physician, nor a rabbi. Historically, a mohel is
considered so vital to a Jewish community that a scholar is
forbidden to live in a community that does not have a mohel.

Eight days old is the age at which G-d commanded the Jewish
people to circumcise their male children - "he that is eight
days old shall be circumcised among you, every male throughout
your generation ..." (Genesis XVII, 12). This mitzvah is so
extraordinary that it can supersede the 'Laws of Shabbat' that
normally prohibit such an operation on Shabbat and holidays. A
brit may only take place during daylight hours; the earlier
the better since we are eager to fulfill a mitzvah
(commandment). The day of birth is counted as the first day,
assuming the child is born before sundown. If he is born after
sundown the following day is the first day of life.

Only certain circumstances justify
the delay of a brit. Above all, a child that is not well may
not be circumcised. Another exception is that, if the eighth
day falls on Shabbat, but your son was born by cesarean
section, the brit is delayed until the next day (Sunday). You
should not delay a brit for convenience nor may it take place
before the eighth day. If a brit is delayed for any reason, it
may not take place on Shabbat or a holiday.

Traditionally, a brit was held in the synagogue to add beauty
and sanctity to the mitzvah. Most parents prefer that a brit
take place at home. The home is generally a warm, familiar
environment. However, the brit may take place anywhere, as
long as it is in a well-lit room large enough to accommodate
all who are present.

If the eighth day falls on Shabbat or holiday, it is
appropriate that the brit take place in a synagogue. In this
way, it is appropriate for those attending the brit to travel,
as they are doing so to daven (pray). However, all supplies and food must be
brought to the synagogue before the start of Shabbat so as not
to carry on Shabbat. The brit may either take place
immediately following the Torah service, but before the Torah
is replaced, or it may take place after the completion of
morning services.

The Ceremony

Brit milah is possibly
the oldest ritual in our nearly 4,000 year history: thus, it
is rich with many beautiful customs. I will describe the
customs I routinely follow, although I am always willing to
incorporate other customs, especially family traditions.

Prior to the ceremony, I will examine your son, apply a
topical anesthetic to his penis or a penile block, and review
the ceremony with you. I normally arrive 30 minutes prior to
the ceremony to do this. The ceremony itself has three parts.
The first part comprises the ceremonial aspect of the brit as
well as the actual circumcision. This part lasts twenty to
thirty minutes. The circumcision itself is very quick, usually
no more than a minute. The second part of the ceremony is the
baby naming. This is usually an emotional event as parents are
encouraged to talk about the person(s) the baby is being named
after, and the characteristics they hope their baby will have
in common with the honored individual(s) who previously bore
this name. The third part of the ceremony is the customary
festive meal (se-udat mitzvah) for all of your guests.

The ceremony itself starts with a
friend or family member lighting the candles. The origin of
lit candles is not clear. The Talmud refers to the practice
during a time when circumcision was prohibited: a lit candle
in a window signaled the community where and when a brit was
to take place. A more spiritual origin may be that a lit
candle represents a spark of life, a new soul entering the
Jewish community.

Following the lighting of the candles, I exclaim 'kvatter'
and one or two appointed guests bring the baby into the room.
As the baby enters the room, everyone stands and greets him
with the words, Baruch Habah! (Blessed is he who enters!) The Kvatter then places the
baby on a chair, which has been set aside for the prophet
Elijah. The chair for Elijah is in recognition of his honor to
be at each brit. Elijah the prophet is called the guardian
angel of children because G-d allowed him to miraculously
revive the lifeless son of a widow in the town of Zarepeth.
Also, Elijah lived in the time of Ahab, king of the northern
kingdom of Israel. Under the influence of Jezebel, Ahab's
wife, people disobeyed G-d's commandments to the extent that
they worshiped idols and did not perform brit milah. Elijah
railed against the people for their false ways, and they
eventually returned to worship G-d and perform brit milah.
Finally, according to tradition, Elijah will return to Earth
to announce the coming of the messianic era. Elijah's chair
thus represents our silent prayer for the baby's safety, a
sign of our faithfulness to G-d's law, and an expression of
our hope that G-d will bring the Messiah soon, perhaps during
the life of the child or even in our own lifetime. For these
reasons, it is customary to decorate this chair.

The father then takes the baby from Elijah's chair and hands
him to the Sandek, who will hold the baby during the
circumcision. The Sandek will place the baby on the pillow
placed on the table on which the circumcision will be
performed. The table on which the brit will be performed is
considered an altar. It can be beautified by covering it with
a blue and/or white cloth, placing flowers and/or pictures of
relatives (especially the person(s) your son will be named
after) on it and the presence of your Kiddush (wine)
cup.

The Sandek holds the baby on the pillow while I recite the
blessing of ritual circumcision and perform
the circumcision. The parent(s) then recites the blessing of
the covenant. I then recite the Kiddush and several prayers of
thanksgiving, and the baby is swaddled and handed to his
mother. I (or a rabbi if present) then perform the naming
ceremony. Usually at this time either the mother or father (or
both) will speak about the person(s) for whom the baby is
named. Any other suitable short readings (poetry or prose) may
be selected for reading or recitation by parents, relatives or
honored guests either at this time or just prior to the
circumcision. Following this, we normally sing and then
celebrate with the festive meal. I customarily stay for 15-30
minutes following the ceremony to allow sufficient time to
ensure that your baby is not experiencing any complications
and has weathered his entry in the Covenant with G-d in fine
shape. During this time, I will change the baby's diaper
with you and go over care of the circumcision.

Some have asked what is done with the foreskin, which is
removed. By custom, it is placed in earth or sand. Some will
do this in their yard and plant a tree in the same spot. They
may then cut a branch of this tree to be used in the huppah
when that son marries. If you would like to bury the foreskin
after your son's brit, please let me know and I will give it
to you. Otherwise, I will dispose of it in an appropriate
manner.

On the following pages I list the honored roles you may wish
your guests to fulfill at the brit. Also following is a form I
need filled out in advance since it provides information
necessary for the ceremony.

Honored Roles

Sandak. This is the most
honored role. The Sandak holds the baby while the brit is
performed. The Sandak should be a Jew who can testify that the
brit was performed in accordance with Jewish law. While
traditionally, the Sandak is a male, there is no reason a
woman cannot be a Sandak. The high esteem in which the Sandak
is held is manifested by a position of honor standing next to
the chair of Elijah. Traditionally, this role is given to a
grandfather. In some communities it is customary to give the
rabbi this honor. And some suggest that the father of the
child should himself be the Sandak, for since the mitzvah to
circumcise the child is incumbent upon him, he should assist
in the ceremony in every way possible. This is the custom in
many Sephardic communities.

Kvatter (male) and Kvatterin (female).
This couple (not necessarily husband and wife) brings the baby
into the room where the brit will take place. They are
colloquially known as the godparents. It is not necessary to
fill both roles.

Candle lighter. Generally a relative or
close friend.

Readers. Parts of the ceremony need not be
read by the mohel. If there are individuals whom you would
like to read the naming ceremony (in either Hebrew or
English), please let me know.

If either the Kiddush cup or candlesticks have special
significance, please let me know so that I can make reference
to them at the brit.

Information for Brit Milah

Your Full NameYour Email addressDate and time of baby's birthBaby's full English nameBaby's Hebrew nameFather's full English nameFather's Hebrew nameIs father a Cohen?Is father a Levite?Is father an Israelite?Mother's full English nameMother's Hebrew nameSandak's nameSandak's relationship to babyKvatter's nameKvatter's relationship to babyKvatterin's nameKvatterin's relationship to
babyCandle lighter's nameCandle lighter's
relationship to babyReader(s)Will a Rabbi be present?Significance of Kiddush Cup and
CandlesticksPhone numberPhone number of the brit
locationAddress of Brit Site

About Circumcision

Circumcision is a common, minor
surgical procedure which is performed about 1.2 million times
per year in the United States. The same procedure (including
sterilized equipment) that occurs at the hospital and the
doctor's office will occur at your home. As an
obstetrician/gynecologist I have performed thousands of
circumcisions on babies I have delivered without any
complications.

In addition to the religious significance of circumcision,
there are some medical benefits. These include a reduction in
urinary tract infections (on the order of three to ten times
less frequent than in those who are not circumcised) and an
almost complete elimination of penile cancer. Sexually
transmitted diseases are less likely to be transmitted if you
are circumcised (including AIDS). There is no evidence that
circumcision affects sexual function or the ability to feel
pleasure. In fact, a survey of adult males suggested less
sexual dysfunction in circumcised adult men.

As with any medical procedure, it
is important to know about the risks. These include bleeding,
infection and a poor cosmetic result. Fortunately, these occur
at a rate of approximately 0.2%, and most of these are minor
bleeding. More serious complications are extremely rare and
are usually related to faulty technique, untrained individuals
performing the procedure, or unsafe circumstances for the
procedure.

The pain of
circumcision can be significantly reduced. I use a combination
of three separate methods for pain relief. First, I have the
parents give Tylenol to the baby before the brit. Second, I
apply a topical anesthetic or an injectable anesthetic to the
penis before the procedure. Lastly I give the baby
either a pacifier or gauze saturated with sweet wine during
the procedure. Parents rarely report any increased fussiness
in the baby after the circumcision.

Please feel free to ask me any further questions regarding
the benefits and risks of circumcision. More detailed
discussion of the benefits and risks of circumcision may be
found in Pediatrics, Volume 103, No. 3, March, 1999, p.
686-693 (American Academy of Pediatrics: Circumcision Policy
Statement).

After you have had a chance to have all your questions
answered, I will have you fill out a routine medical consent
form prior to the brit. I have enclosed this as the last page
of this document for your information.

Guidelines for Caring for Your
Newborn's Circumcision

Here are a few guidelines to help you care for the
circumcision in the first few days after the brit milah ceremony.

Care of the circumcision is quite simple.
Circumcisions generally heal by themselves. The object
of care is to keep the area of the surgery as clean and
comfortable as possible until the tissue heals.

There is a gauze square with petroleum jelly on the baby's
penis. The first time you change him, leave the gauze. The
second time you change his diaper throw away the gauze. If
the gauze should fall off before this time do not attempt to
replace it. When you change the diaper, clean the diaper
area, leaving the penis alone. If you wish to wash the area
of the circumcision, or if stool gets on it, use a cotton
ball and warm water to gently clean the skin. Do not use
alcohol and do not rub the tissue with any force as this may
cause bleeding.

It is not necessary to use gauze again, but every time you
change him for the next five to six days place some
petroleum jelly (about one teaspoon) around the entire
circumference of the cut. Continue this until the area looks
healed.

The local anesthetic will last about one hour. While many
babies do not seem to be in any distress after the
circumcision, some may be uncomfortable for the first two or
three days, especially when their diapers are being changed
or when their urine initially comes into contact with the
raw tissue. Feeding or nursing should not be affected. You
may give your baby some liquid infant Tylenol for the first
twenty-four hours if he is irritable. The dose is 1.25cc
every six hours. There is a mark on the dropper.

Healing is usually rapid. You should remember that this is
like any other cut and there are many factors that influence
healing, but most importantly every child heals differently.
First, the cut edge seals and bleeding ceases within
minutes. Within twenty-four hours the area behind the glans
will become swollen; this inflammation will subside within a
week or two. In a day or two there may be an off-white or
yellowish, patchy appearance of the glans. These patches are
a type of scab and are associated with normal healing. You
will also notice that the glans is red and glossy. This is
because the skin covering the glans of an uncircumcised
penis is mucous membrane (like the skin inside your cheek).
Once exposed, the mucous membrane will toughen (or
keratinize) and in time take on a normal appearance (like
the skin outside your cheek). The penis should take on a
'normal, healed appearance' in about a month. As the
circumcision is healing, gently push the
skin of the shaft of the penis toward the abdominal wall to
expose the entire glans (head of the penis). This will
prevent adhesions from reforming between the glans and the
skin of the shaft.

What to watch for:

There may be a small amount of blood on the gauze. This is
normal. If there is a flow of blood, pressure for five
minutes (watch the clock) will usually stop it. If the
bleeding persists, call your pediatrician or me.

There will be some redness and swelling at the area of the
circumcision for a few days. This is normal. If the swelling
extends down the shaft and onto the abdominal wall you
should call. Infection is extremely rare after circumcision.

Since part of the circumcision is on a mucous membrane, a
yellowish-gray area may form at the site of the cut. This
may be similar to what you see at the site of the umbilical
cord insertion. This is NOT pus and does not represent
infection, but is normal for the healing process.

On occasion, a poor aesthetic result occurs when too
little or too much skin is removed, or more likely when the
cut edge of the skin attaches too high or too low along the
length of the penis. In nearly all cases the penis will heal
properly and in time take on a normal appearance.

The circumcision should be entirely healed within seven or
eight days. If you have questions you may call me at (202)
841-3329.

About April Rubin

Following completion of Internship and Residency training at
the University of Chicago, April Rubin M.D. has practiced
obstetrics and gynecology on Capitol Hill since 1982. She has
performed well over 1,000 medical circumcisions on babies she
has delivered. In 2003 Dr. Rubin was designated a mohel
(feminine: mohelet) in the Conservative Movement of Judaism
after completion of the Brit Kodesh course at the Jewish
Theological Seminary in New York. She now performs 50-60 brit
milah, brit le'shem gerut (brit for purposes of conversion),
hatafat dam (conversion of a previously circumcised male) and
brit bat (naming ceremony for a girl baby) each year.

Items Needed for the Brit

It is necessary for you to provide the following
items at the brit(I will bring everything
else):

A sturdy table (not a folding table) with a good light
source. On the table you should place candles (with matches
to light them) and a Kiddush cup. In addition, my
instruments will be on the table. It is nice to have the
table covered with a decorative white or blue cloth cover.
There should be a trash can or garbage bag under the table.

Two sturdy chairs, one for Elijah and one for the Sandak.

Kosher Concord grape wine. The Kiddush cup should be
partially filled with wine.

Challah, to start the festive meal.

Baby wipes, bulb syringe, diapers, pacifier, and
petroleum jelly.

Pillow, standard size. As it is common for babies to
urinate just prior to, or after the circumcision, please do
not use a pillow, which may be ruined by urine.

Tallit for the father and Sandak; yarmulkes for the
guests.

The baby should wear a gown that can be raised above the
diaper level.

Other Instructions

Feed the baby just prior to my arrival. In this way he
will be less fussy during or just after the brit. Please
give him 2.5cc of infant Tylenol or Tempra (concentration
should be 160 mg/5cc) one hour before the scheduled time of
the brit milah. This, along with the cream I will put on the
penis when I arrive will ease the discomfort of the
circumcision.

Turn off phones before the ceremony. Place a sign on the
door that reads "Please come in" so that guests will not
knock on the door during the ceremony.

A minyan (ten Jewish adults) is not necessary, but is
preferred. Have your guests come fifteen minutes before the
start of the ceremony so that it may begin on time.

Photographs and video are fine (except on Shabbat),
although I ask that you refrain from photographing the
actual circumcision.

Your son's penis should be examined by his physician
before the day of the brit. This will reduce the chances of
a last minute postponement for any sort of health reason.
Prior to the ceremony, I will want to examine the
baby. In a separate room, there should be either a
table or changing board on which I can examine him. In
addition, there should also be a trash can or garbage bag.
Should your son develop any medical problems prior to the
brit milah please let me know.

Please feel free to call me at any time at 202-841-3329 to
discuss anything in this handout or otherwise pertaining to
the brit milah of your son.

Consent Form

Except in the circumstance of a brit on Shabbat,
there is no need to submit this form in advance.
However, at the time of the ceremony you will be asked to sign
the following consent form prior to your son's brit milah.

I request that my son be circumcised by Dr. April Rubin as
part of the brit milah ceremony.

I understand and agree that this circumcision is not intended
to establish a patient/physician relationship and that it is
part of a religious ceremony and not being performed as a
medical treatment or procedure.

In signing this form for a circumcision I affirm that Dr.
Rubin has explained the procedure, its risks and potential
complications, including, but not limited to, bleeding,
infection, removing too much or too little foreskin, trauma to
the penis and the need for further surgery. I understand
that it is impossible for Dr. Rubin to inform me of all the
potential complications that may occur.

I affirm that I understand the above-mentioned risks
regarding the procedure and that Dr. Rubin has explained
post-circumcision management to me.

I affirm that Dr. Rubin has answered all of my questions
regarding the procedure to my satisfaction.